Return-to-sport testing: how to know you're ready

By Geoff Scott, Founder & Senior Physiotherapist, Hauora

By Geoff Scott, Senior Physiotherapist and founder of Hauora. Last updated 14 November 2026.

What is return-to-sport testing?

Return-to-sport testing is a set of objective checks of strength, power, movement and fitness that shows whether an injured athlete is ready to train and compete again. Instead of relying on how much time has passed or how the injury feels, it compares the injured side with the healthy side and with the demands of your sport.

In professional football, the decision about when an injured player rejoins training is based on testing, not a date in the diary. Geoff spent years as Head of Medicine at Tottenham Hotspur and has written for The Athletic about the tests Premier League footballers go through in pre-season. At our clinic in Primrose Hill we use the same principles for footballers, runners, rugby and netball players, padel players and anyone who wants to get back to their sport with confidence.

Return-to-sport testing at a glance

  • Passing tests matters: after ACL reconstruction, 38% of people who returned to sport without passing return-to-sport criteria injured their knee again, compared with 5.6% of those who passed.
  • The usual pass mark is 90%: the injured leg should reach at least 90% of the other leg’s strength and hop distance.
  • Strength is the big one: more symmetrical quadriceps strength before returning was linked to fewer knee re-injuries.
  • Time still counts: after ACL surgery, the re-injury rate fell by about half for each month that return to sport was delayed, up to nine months.
  • Confidence is tested too: fear of re-injury affects performance and is measured alongside the physical tests.
  • It’s a process, not a single test: international consensus describes return to sport as a continuum, from modified training to full performance.

Why time alone isn’t a good guide

Healing timelines are averages. Two people with the same injury, at the same point after it, can be in very different shape: one has rebuilt their strength and control, the other still has a 30% deficit they can’t feel. The research is clear about what happens when people go back on time alone. In a study of 158 professional athletes after ACL reconstruction, those who returned without meeting all six discharge criteria had about four times the risk of rupturing their new graft. In the Delaware-Oslo ACL cohort, simple test-based decision rules were linked to an 84% lower re-injury risk.

Time and testing work together. A minimum time protects healing tissue, and testing confirms the body is actually ready.

The return-to-sport continuum

The 2016 international consensus statement on return to sport, agreed by experts in Bern, describes three stages rather than a single yes-or-no decision:

  1. Return to participation: you’re training, but in a modified way, or playing at a lower level than you were
  2. Return to sport: you’re back in your sport at your previous level, but not yet performing at your best
  3. Return to performance: you’re performing at or above your pre-injury level

Testing guides each step. Passing one stage earns you the next, and we keep building strength and fitness after you’re back so you stay there.

What we test, and the pass marks

1. Strength

We measure the strength of the key muscles for your injury and compare sides: quadriceps and hamstrings after a knee injury, hamstring strength at long muscle lengths after a strain, calf endurance after an Achilles or ankle problem, adductor strength after a groin injury, and rotation strength after a shoulder injury. The usual target is at least 90% of the uninjured side.

2. Hop tests

The standard battery is a single hop for distance, a triple hop, a crossover hop and a 6-metre timed hop, each compared side to side with 90% as the usual pass mark. We watch how you land as well as how far you go. A good score with a wobbly, stiff landing isn’t a pass.

3. Running, sprinting and change of direction

You progress from straight-line running to sprinting at increasing intensities, then cutting, turning and agility drills. For footballers this includes repeated sprints and the kind of high-speed running you’d do in a match, because that’s where most hamstring injuries happen.

4. Sport-specific skills and full training

Kicking, jumping, landing, tackling and contact are reintroduced in a controlled way, then full training. Matches come last, and match minutes are built up gradually.

5. Confidence and readiness

Questionnaires such as the ACL Return to Sport after Injury scale (ACL-RSI) measure confidence and fear of re-injury. A low score doesn’t mean you can’t go back. It tells us there’s more work to do, often more exposure to the movements you’re worried about.

6. How the injury responds

No swelling, full range of movement, and pain that stays within agreed limits and settles by the next day after hard sessions.

Return-to-sport tests by injury

  • ACL reconstruction: quadriceps and hamstring strength and four hop tests at 90% or more, running and agility, the ACL-RSI, and usually at least nine months after surgery
  • Hamstring strain: pain-free sprinting at maximum speed, hamstring strength including at long muscle lengths, and no apprehension in fast stretching movements
  • Achilles tendon: single-leg calf raises compared with the other side, hopping and a full running progression
  • Ankle sprain: single-leg balance, hop tests, and cutting and landing without hesitation
  • Groin injury: adductor squeeze strength, the Copenhagen exercise, kicking, sprinting and change of direction without pain
  • Rotator cuff and shoulder: rotation strength compared with the other side and full tolerance of throwing, serving or overhead work

What if you don’t pass?

Not passing isn’t failing. It shows exactly what’s missing, whether that’s 15% of quadriceps strength, a poor landing or a lack of high-speed running, so the next few weeks of rehab can target it. Most people pass on a later retest. Going back before you pass is a decision with real risk, and we’ll always explain that risk clearly.

Return-to-sport testing at Hauora

Testing is part of every rehab programme we run. We measure your strength, hop distance, running and confidence against clear targets, explain the results in plain language and agree the next step with you, and with your coach or surgeon if you’d like. If you’ve rehabbed elsewhere and want an objective check before you go back, book an assessment and tell us that’s what you need. You’ll be seen by Geoff Scott or Jason Oliveira, both senior physiotherapists with elite-sport backgrounds, and our strength and movement coaching can close any gaps the tests find.

Frequently asked questions

What is a return-to-sport test?

It’s a set of objective checks of strength, hopping, running, sport-specific movement and confidence that shows whether you’re ready to go back to your sport after an injury. Results are compared with your uninjured side and with the demands of your sport.

What is a good limb symmetry index?

Most return-to-sport protocols use 90% as the pass mark, meaning the injured leg should achieve at least 90% of the uninjured leg’s strength and hop distance. For high-level and pivoting sports, many clinicians aim higher.

How long after ACL surgery can I return to football?

Usually not before nine months, and only once you’ve passed return-to-sport testing. In a major study, the risk of re-injury fell by about half for each month that return was delayed, up to nine months after surgery.

Can I pass a return-to-sport test and still get injured?

Yes. Testing lowers the risk but can’t remove it. That’s why we keep strength and conditioning work going after you return and build up your training and match time gradually.

Do I need return-to-sport testing after a minor injury?

A short version, yes. Even after a mild hamstring strain or ankle sprain, checking strength, sprinting and balance against the other side takes minutes and lowers the chance of the injury coming back.

Does Hauora do return-to-sport testing?

Yes. We test strength, hopping, running and confidence before our patients go back to sport, and you can book an assessment if you’ve rehabbed elsewhere and want an objective check first.

Related reading: returning to sport after injury: the elite approach, ACL rehabilitation in London and hamstring injury rehab.

Return-to-sport testing in Primrose Hill, St John’s Wood and Belsize Park

If you’re coming back from injury and want to know you’re ready, book an assessment at Hauora, an independent physiotherapy clinic at 44 Gloucester Avenue, Primrose Hill, London NW1 8JD. We’re close to Chalk Farm and Camden Town stations and easy to reach from St John’s Wood, Belsize Park, Swiss Cottage, Hampstead, Regent’s Park, Marylebone, Kentish Town and Maida Vale. Book online at hauora.com/book or call 020 4541 8924.

Finding us: Hauora is based inside the At The Core building, but we’re a separate business from At The Core. We share the building and the phone number, so when you call, please ask for Hauora.

This article is general information, not a diagnosis. If you’re injured or unwell, see a doctor or physiotherapist.

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